What to Do When You Can't Get Pregnant

PRAISE FOR WHAT TO DO WHEN YOU CAN’T GET PREGNANT

“Dr. Potter and Jennifer Hanin have done an outstanding job of discussing state-of-the-art medical information in an accurate and easily graspable framework for couples going through infertility. The authors offer valuable insight into the diagnosis and treatment of infertility with a supportive and inspiring energy that encourages the reader to take positive steps. What to Do When You Can’t Get Pregnant should be required reading for all patients and their partners as they enter the world of infertility, where everything from low tech diagnostic tests (HSG and FSH) to high tech procedures (IVF, ICSI, PGD) can otherwise appear to be little more than alphabet soup. In all, it is a most readable, comprehensive discussion that delicately weaves personal touches and evidence-based medicine to provide up-to-the minute information in a manner that is clear and helpful to all who read it.”

—ALAN B. COPPERMAN, MD,

Director of Reproductive Endocrinology,

Vice-Chairman of Obstetrics and Gynecology,

Mount Sinai Medical Center, New York

ABOUT THE AUTHORS

DANIEL A. POTTER, MD, FACOG, is a world-renowned reproductive endocrinologist and practice director of the internationally acclaimed Huntington Reproductive Center Medical Group in California. Dr. Potter is a frequent speaker at numerous hospitals, conferences, and associations, including The American Society for Reproductive Medicine and The American Fertility Association. An advocate for women’s health care, Dr. Potter also serves as medical director of MicroSort West, director of reproductive medicine and surgery at Anaheim Memorial Medical Center, and assistant clinical professor of Obstetrics and Gynecology at the University of Southern California Keck School of Medicine. Dr. Potter and his wife live in Southern California with two daughters conceived through in vitro fertilization.

JENNIFER S. HANIN, MA, is a freelance journalist and the mother of twins conceived through in vitro fertilization. Ms. Hanin began her career in radio and television before assuming public relations and marketing roles for major corporations including Compaq, Honeywell, and RE/MAX. She holds an M.A. in Public Relations from the University of Houston, and is author of a master’s thesis: Public Relations as Negotiation: a case study of the Dow Corning Corporation in the silicone-gel breast implant controversy. She has a social service background working with parents and children, and holds a B.S. in Human Development and Family Studies from Texas Tech University. Ms. Hanin lives in southern California with her husband and daughters.

ACKNOWLEDGMENTS

WRITING A BOOK is no different than going through IVF. Like the bevy of appointments, medications, and shots, a book requires tons of research, interviews, and dedication. Both require the input and wisdom from a welter of people. In either case, two pairs of hands are not enough.

Our idea would have never have gotten past our computers without the support and encouragement from Dr. David R. Marks. He spent many late nights poring over our initial chapters after putting in long hours delivering newscasts at WNBC TV (now at WCBS TV) in New York.

Our book would not be what it is today without invaluable insights from experts who spend their days helping couples become parents. Special thanks goes to Pamela Madsen, founder and executive director of the American Fertility Association for writing a foreword that gives our book a running start; Dr. Barry R. Behr with Stanford University and Huntington Reproductive Center for taking us behind the scenes of a modern day fertility lab; Dr. Aaron Spitz with Orange County Urology Medical Associates for giving us a closer look at male infertility; Dr. Janet Hornstein, Maternal-Fetal Medicine in Los Angeles for discussing the health concerns surrounding multiple pregnancies; Dr. Daniel Lee, Acupuncturist and Herbal Medicine specialist in Laguna Hills for giving us the latest information on how Chinese medicine helps couples overcome infertility; and Christina (Christy) Jones, founder and CEO of Extend Fertility, Inc in Boston for educating us on the practice of egg freezing; and to all the individuals at the Southern California based Huntington Reproductive Center who supported our efforts along the way namely Dr. I. Lane Wong, Charlotte Khoury, Claire Teagle, Maria Purifkacion, Alicia Potes and Jackie Sharpe.

There’s no question that having a knowledgeable therapist on hand who specializes in infertility/third party reproduction can make your journey more meaningful. Great appreciation goes to Karen Chernekoff, marriage and family therapist in Orange County who shared the ins and outs of third party reproduction. And there’s no doubt that anyone attempting a third party contract needs sound legal counsel. Much gratitude goes to Andrew W. Vorzimer, attorney for the Center for Surrogate Parenting and managing partner of Vorzimer and Masserman in Beverly Hills, and Steven Lazarus, attorney specializing in third party reproduction and adoption in Los Angeles. Both gave us a glimpse into what intended parents need to know before going forward with a donor, surrogate, or adoption agreement.

Many thanks go to Robert (Bob) Morreale with the Cleveland Institute of Art, Eve Herold with the Stem Cell Research Foundation, and Dana Jessup with Serono, Inc. for contributing illustrations that are critical to our readers.

Special accolades go to Diane Sagey for recommending a notable photographer, to Sage for coordinating the photo shoot, and to Randy Logan at the 24 Street Studios, Inc. in Santa Ana for contributing his time, talent, and vision for an unparalled photographic experience.

This book would never have come to pass without the support and advice from our editor Sue McCloskey at Marlowe & Company. We can’t thank her enough for polishing our manuscript until it took on the right sheen.

We would be remiss if we didn’t extend our gratitude to the rest of the staff at Marlowe & Company for dedicating their time and energy to birth this book. Much praise goes to Vince Kunkemueller, managing editor; Joanne Slike, copyeditor; India Amos, interior book designer; Mauna Eichner, cover designer; and Michael Sandlin, proofreader.

Then there’s Jodie Rhodes, our agent, who encouraged us and ran with our proposal from day one.

A world of thanks goes our publicist, Sarie Morrell-Sanchez who believed in this book enough to volunteer her time to support our publisher’s efforts. Her enthusiasm and savvy helped get our book noticed above and beyond our wildest expectations.

Heartfelt appreciation goes to Adam Hanin, who spent countless hours reviewing our chapters, generating 30 illustrations, graphs, and tables, designing a comprehensive glossary, and cheering us on every step of the way.

Much gratitude goes to Marlene Noeth, who is creative, energetic and a superb nanny. We can’t thank you enough for coming in early, staying late, and keeping everything running smoothly while we put the finishing touches on our manuscript.

Most of all, our book would not be the same without the courageous couples who shared their stories. While we won’t acknowledge each individually to protect their anonymity, they know who they are. They were humble, forthcoming and generous enough to let others feel the heartache of not being able to conceive and what they did about it. All took the unbeaten path like we did and the same one that many of you may soon embark on. Their experiences are rich and compelling and shed light on complex issues that tug at the hearts of infertile couples everywhere.

THE INFORMATION IN THIS BOOK is intended to help readers make informed decisions about their health and the health of their loved ones. It is not intended to be a substitute for treatment by or the advice and care of a professional health care provider. While the authors and publisher have endeavored to ensure that the information presented is accurate and up-to-date, they are not responsible for adverse effects or consequences sustained by any person using this book.

FOREWORD

LET’S BE HONEST. That is what’s at the heart of this book. Honesty. Full disclosure about the acts we humans hold most intimate: sex and procreation. The mere fact that you’re perusing this exquisite compendium of reproductive facts, treatment options, suggestions, ideas, and hopes says that you’ve summoned the courage to reckon with some hard truths.

Now let’s be real: you’ve been trying to conceive and it hasn’t happened. Maybe you’ve been aiming for pregnancy for six months, a year, or three years. Maybe you’ve talked about it with your partner, your doctor, or your friends. Maybe you haven’t. Maybe you’re gung-ho about getting help and your partner is foot-dragging. Maybe you’re reticent, nervous, or scared. Everyone’s situation is singular. But there is one universal imperative binding all of us while holding this book: the search for understanding.

Understanding is a complex notion. By this I mean we need coherent medical definitions and explanations of the male and female reproductive systems, comprehensible analyses of the vast array of glitches and hitches that could impede spontaneous conception. And we need to know what to do—and what not to do—about them. Daniel A. Potter, MD, FACOG, a renowned fertility expert, and freelance journalist Jennifer S. Hanin, MA, provide a near encyclopedic fertility reference that answers questions we might not even think to ask but should.

By understanding, I also mean empathy. The authors speak directly to us as peers and comrades in the struggle to overcome infertility. Both Dr. Potter and Ms. Hanin have experienced emotional, psychological, and physical trials of infertility. They’ve both been through the assisted reproductive technology (ART) mill to build their own families.

With great compassion and humor, Potter and Hanin illuminate every nook and cranny of the often Byzantine world of fertility and reproductive medicine. They tackle everything from enhancing your fertility to low and high-tech treatments. They deal with sensitive topics such as third and fourth party reproduction, preimplantation genetic diagnosis, and gender selection with a gentle hand and refreshing candor.

Chances are if you’re initially questioning whether or not you’ve even got a “problem,” these issues seem remote. Trust me, they’re not. As the mother of two wonderful IVF sons and the Executive Director of the American Fertility Association (AFA), the nation’s largest fertility patient advocacy and education organization, I can vouch for the power of the child-quest to blind you to practical realities. The AFA comes in contact with tens of thousands of people every year who are overwhelmed by the scores of decisions they must make, sometimes at a moment’s notice.

For all of us who wrestle with conception difficulties, Potter and Hanin have given us the gift of forethought. If you follow their guidelines for a fertile lifestyle and are lucky enough to conceive spontaneously, then you’ve already reaped the benefits of their work. If you’re among the millions who plunge into the universe of ART, this resource will help you craft a plan so you’re aware, and maybe even prepared for all contingencies.

So read on. This book will become a trusted friend. You’ll go back to it at different stages in your family-building journey and come away supported and knowledgeable. Before you know it, you’ll be ready to take on whatever comes next. And that’s no small thing.

PAMELA MADSEN
Executive Director
The American Fertility Association

INTRODUCTION

FOR YEARS, MY husband, Adam, and I wanted to have a child. We followed advice from family, friends, and even a few armchair experts in hopes of having a baby. Besides synchronizing our lovemaking to the days I ovulated and an occasional romantic getaway, we changed our diet, got our mind and body in shape, and still nothing. At 38, we knew that if we wanted to be parents we had to act fast.

After researching fertility programs on the Internet, we made a joint decision to seek treatment. Once we committed to in vitro fertilization (IVF), we realized we knew nothing about it. We searched for books that might guide us through the process but came up with zilch. The fertility books on the market were dry, clinical, or only focused on getting pregnant through natural solutions. None provided what we needed most: an easy-to-read, up-to-date, upbeat account of what fertility treatment is like from couples who have been there.

Our initial meeting with Dr. Potter put us at ease. Besides having strong ties to Texas like me, he and his wife have two daughters as the result of IVF. One month into our treatment and pregnant with twins, I approached him with the idea of writing this book. I explained what the market is missing: a book written in a conversational voice from the patient’s perspective describing what to expect during fertility treatments. We agreed that besides being medically accurate, the book needed to inform readers on current and emerging treatments and technologies. We left the meeting with one goal in mind: writing the kind of book we would like to have read before our own fertility treatments.

Together, we have organized What to Do When You Can’t Get Pregnant to take you step-by-step through the process. Between these covers, you’ll discover insights into every facet of fertility. Our challenge was to break through the medical jargon and describe in everyday terms why you’re not getting pregnant and what you can do about it. We believe we have done this.

From the start, we wanted to personalize this book. We know that both men and women will read this book, but we realize the majority of our audience is women. So we’ve geared our language toward women, speaking directly to them. But men, read on. There is plenty of important information for you.

We know that some of our readers will be in same-sex relationships or may not have a partner at all. While we may talk about your partner as being male, our book holds value for folks in every situation.

Obviously, some of your doctors will be female and some will be male. While we did our best to alternate between genders, there may be times that we refer to your doctor as one gender when your doctor is really the other.

Chapter 1 opens by explaining the fertility process and why getting pregnant is often difficult. Subsequent chapters discuss what happens in a fertility evaluation and describes what conditions your doctor may find that keeps you or your partner from conceiving.

There are a number of treatments at your disposal, and we discuss your options. But just as important as your treatment is living a fertile lifestyle. We discuss countless ways that you can boost your fertility. And since infertility treatment can often cause additional stress in couples’ lives, we have dedicated a chapter to preserving and fine-tuning your relationships. While assisted reproductive technologies work for thousands of couples each year, there are always instances where nothing works. In situations like this, we discuss alternative parenting options and when you need to consider moving on.

Because you’ll want to do everything in your power to prevent your unborn baby from hereditary illnesses, we discuss prescreening your child for genetic diseases. Now that technology is available to choose your child’s gender, we discuss how parents that already have one child can prescreen for a child of the opposite sex. Discussing new technologies such as prescreening for genetic diseases and sex selection opens the door to other controversial issues including designer babies and those that remain outside of reproductive medicine like cloning.

We explain how extreme procedures like ovarian tissue transplant and cytoplasmic transfer may one day become routine procedures to help women conceive and address why cloning won’t be one of them. Our book closes with what you can expect in reproductive medicine over the next few decades (and what may never come to pass), including emerging technologies, ever-changing insurance laws, and the movement toward government regulation.

Finally, our introduction wouldn’t be complete without mentioning the couples whose lives we interwove into our book. Besides graciously agreeing to tell their personal stories, each one of them shares the same goals we do: saving you time, money, and energy. Because we’ve all been there before, we want to ensure your fertility experience is as comfortable and pleasant as possible. Whatever path you choose, we hope this book makes your trip worthwhile.

JENNIFER S. HANIN, MA